PUBLIC DOCUMENT . No. 56. FIFTH ANNUAL REPORT O P T H E Board of Registration in Medicine. J a n u a r y , 1899. BOSTON: WRIGHT & POTTER PRINTING CO., STATE PRINTERS, 18 P ost Offic e Sq u a r e. 1899. Commonlueiiltlj of Jilassucliusctts B oard of R egistration in M e d ic in e , S ta te H ouse, Dec. 31, 1898. To His Excellency R oger W olcott, Governor. Sir :—In compliance with the requirements of chapter •158 of the Acts of the year 1894, the Board of Registration in Medicine submits the following report for the current year. Since the publication of the last annual report the number of individual examinations conducted by the Board is 492 ; the number of persons refused registration by reason of their inability to pass a satisfactory examination is 134. Besides the three regular meetings provided for by the registration act, one in March, one in July and one in November, the Board has held two special meetings for the examination of applicants. The number registered and the number rejected in the several examinations during the year are as follows : — Percentage Registered. Rejected. Rejected. March examination,................................ 52 36 40 May exam ination,................................ 51 10 16 July exam ination,................................ 162 43 21 September examination, .... 37 10 20 November examination, .... 56 ,3& 38 -1 The number of persons applying for registration since the beginning of the current year is 395, all of whom except 13 have taken the required examination. Deducting 382, the number of this year’s applicants who have been ex- 4 REGISTRATION IN MEDICINE. [Jan. amined, from 492, the number of examinations given this year, the remaining 110 represent the number of re-exam­ inations. Undoubtedly it was the intention of the Legislature in 1894 to provide in the registration act for but one re-exam­ ination of a rejected applicant without additional payment; but it is held that the law, strictly interpreted, entitles a rejected applicant to a re-examination at any and every regular meeting of the Board within the two years next fol­ lowing the date of his first unsuccessful examination. It happens, therefore, that a considerable number of rejected applicants appear at each regular meeting, just, as they say, to try their luck. In the opinion of the Board, such fre­ quent re-examinations do not result advantageously to the individual. They may indeed prove disastrous to him, from the fact that he may rely upon the possibilities of success as a chance result from frequent attempts, rather than on further study to equip himself for the test. To provide for one re-examination would be a just and a reasonable pro­ vision of the law. The Board recommends that the law be so amended. Applicants are examined at the regular meetings of the Board and at special meetings called for the purpose when­ ever deemed necessary. The regular meetings are held on the second Tuesday in March, July and November. Each meeting for the examination of applicants occupies the time of the full Board two days in the class room, and from three to six days in rating the written work submitted. Ten questions are given in each of the subjects on which the examination is conducted, and two hours allowed in which to answer the same. The applicant is required to designate his papers, not by his signature, but by the number desig­ nating his application, stamped thereon and quoted to him in the notice of his examination date. This requirement assures an incognito rating of all papers. When the gen­ eral average of the ratings returned to the secretary by the examiners of the several papers of an applicant falls below 70, his examination is regarded as unsatisfactory, and reg­ istration is refused. Applications for examination must be 1899.] PUBLIC DOCUMENT — No. 56. 5 made upon blanks furnished by the Board, and must be accompanied by the required fee, which is twenty dollars. Certificates of registration in other States, or diplomas of graduation from medical colleges, do not exempt from examination. The law requires that the examination shall be of an “ elementary and practical character, and shall embrace the general subjects of surgery, physiology, pathology, obstet­ rics and the practice of medicine ; ” but, inasmuch as the law also requires that the examination shall be “ sufficiently strict to test the qualifications of the candidate as a practi­ tioner of medicine,” the Board could not discharge its duty fully should it limit its list of questions to the particular branches mentioned. A thorough knowledge of anatomy is indispensable. Without it no one can be considered quali­ fied to practice medicine. At the examination in November, the last held, 91 appli­ cants were present. The questions submitted to the class were the following : — Surgery. 1. Diagnose intra-capsular fracture of the neck of the femur. Describe treatment. 2. Acute arthritis of the knee. State diagnosis and treat­ ment. What may result from the inflammation? 3. Mucous nasal polypi, — diagnosis, manner of development and treatment. 4. Describe operation for restoring an old rupture of the perineum. 5. Mention the surgical diseases of the testicle. Give diagnosis and treatment of any one of them. 6. Differentiate organic from spasmodic stricture of the oesoph­ agus, and state symptoms and treatment of both. 7. State diagnosis, etiology and treatment of catarrhal con­ junctivitis. 8. How would you prepare a patient for amputation of fore­ arm? Describe your favorite operation for amputation at the middle third, and name the arteries usually requiring ligation. 9. Describe primary and secondary symptoms, and results you would expect in lacerated wounds of the abdomen. How would you treat peritonitis in such a case ? 10. Describe diffuse abscess, and give etiology and treatment. 6 REGISTRATION IN MEDICINE. [Jan. Physiology. 1. Describe connective tissue and give its function. 2. Of what value is sugar as a food? 3. What becomes of moderate quantities of alcohol when taken into the system ? 4. Give the functions of the saliva. 5. Describe the two main cavities of the body, and name the organs contained in each. 6. Give the function of bone marrow. 7. Give the causes of the heart sounds. 8. Give constituents of blood. 9. What becomes of the worn-out blood corpuscles? State functions of the white blood corpuscles. 10. What becomes of digested food? Pathology. 1. Describe the varieties of inflammation of the skin. 2. A renal artery has been occluded. Describe the affected kidney. 3. Where may inflammation exist without producing redness? 4. What processes are affected by fever? 5. Describe the substance designated as colloid. 6. Tell what you can about effusions. 7. What agencies other than microbia may cause pus forma­ tions ? 8. Describe a thrombus and tell how it is produced. 9. Describe the conditions embraced in the term cloudy swelling. 10. Describe the structure of the usual varieties of sarcoma. Obstetrics. 1. Describe the bones of the pelvis. 2. Under what abnormal conditions is decapitation of the fœtus indicated ? 3. Give two functions of the placenta. 4. What are the functions of the liquor amnii? 5. How may latent malaria be affected by pregnancy? 6. A multipara has been in labor five hours, the membranes are ruptured, the right hand and pulsating cord are presenting in the vagina. Treatment. 7. What changes take place in the mucous membrane of the uterus during pregnancy? 8. A primipara at the sixth month of pregnancy has a small but increasing bloody discharge. She has no pains, nor is there any history of accident or injury. Discuss the probable diagnosis. 1899.] PUBLIC DOCUMENT — No. 56. 7 9. How are varicose veins of the vulva treated? 10. Give the symptoms of puerperal septicaemia. Medicine. 1. In pneumonia, state average range of temperature, duration and modes of termination. 2. How would you obtain some of the contents of the stomach for examination after a test meal ? 3. In hfematuria, give methods of determining source of blood. 4. Name the varieties and casts in different forms of nephritis. 5. Give symptoms, treatment and prognosis of diabetes mellitus. 6. Differentiate mitral from aortic obstruction. 7. Differentiate amyloid disease from scirrhous of the liver. 8. In poisoning from arsenic, what organs (besides the stomach) usually contain the largest amount of the poison ? 9. Prescribe a diet for anaemic patients, and state the reasons for the same. 10. Write out a schedule for obtaining and keeping the history of a medical case. No one competent to judge will claim that the above is too severe a test of one’s qualifications to practise medicine. The necessity for such an examination is clearly shown by the fact that 38 per cent, of the class taking it were refused registration. Seventy of the class wore graduates from medical schools considered reputable, nearly all being recognized by the American Medical Association; 19 of them were rejected as unqualified to oiler their services to the public as physicians and surgeons. The following ex­ cerpts from their examination papers may be of interest, especially to educators in medical schools and to the pro­ fession. No one is quoted more than once, and in every instance the answer is exact as to spelling, punctuation, capitalization and phraseology. Q. Tell what you can about effusions. A. effusion is a pouring out of the serous membrane a fluid called serum into a cavity such as the plura or serous mem­ brane of the knee the effusion begin first by iretation of the serous membrane the blood vessels begin to dilate and through the serum. 8 REGISTRATION IN MEDICINE.